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Teixeira JBDC, dos Santos KC, Guedes PEB, Vitor RC, Bitar TV, Harvey TV, Sevá ADP, Carlos RSA. Tungiasis: Participation of Cats and Chickens in the Dispersion and Maintenance of the Disease in an Endemic Tourist Area in Brazil. Trop Med Infect Dis 2023; 8:456. [PMID: 37888584 PMCID: PMC10611092 DOI: 10.3390/tropicalmed8100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/18/2023] [Accepted: 09/02/2023] [Indexed: 10/28/2023] Open
Abstract
Tunga spp. are fleas commonly found in impoverished tropical regions. In Vila Juerana, a tourist community in Ilheus, Bahia, Brazil, where tungiasis is endemic, dogs are the main host of fleas during their life cycle. However, there is no information about the role of cats and chickens in tungiasis in the village. Of the 272 households investigated, 112 had domestic animals, 48 had only dogs, 28 had only cats, and nine had only chickens. Of the 27 households with cohabitation among species, 16 had cats and dogs, eight had chickens and dogs, and three had dogs, cats, and chickens. The injuries due to tungiasis were ranked according to the Fortaleza classification, considering stages I, II, and III as viable lesions. The paws/feet of 71/111 (63.9%) cats and 173/439 (39.4%) chickens were inspected. Dogs that lived with positive cats and chickens also were inspected. Among the 38% (27/7; 95% IC 26.74-49.32) positive cats, 16 cohabited houses with infected dogs but none lived with positive chickens. Of the chickens, 2.3% (4/173; 95% IC 0.07-4.5) had lesions caused by tungiasis. In each household where a cat was infected, the dog was also positive. Two chickens cohabited with an infected dog and the other two did not coexist with other species. Cohabitation with infected dogs and the absence of house confinement restrictions in Vila Juerana make cats important carriers that spread tungiasis in this community. Chickens had a low frequency of tungiasis lesions despite living in proximity to infected dogs and cats.
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Affiliation(s)
- Jamille Bispo de Carvalho Teixeira
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Katharine Costa dos Santos
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Paula Elisa Brandão Guedes
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Rebeca Costa Vitor
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Thammy Vieira Bitar
- Departamento de Ciências Agrárias e Ambientais (DCAA), Curso de Medicina Veterinária, Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil;
| | | | - Anaiá da Paixão Sevá
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
| | - Renata Santiago Alberto Carlos
- Programa de Pós-Graduação em Ciência Animal—PPGCA, Departamento de Ciências Agrárias e Ambientais (DCAA), Universidade Estadual de Santa Cruz (UESC), Ilhéus 45662-900, Bahia, Brazil; (J.B.d.C.T.); (K.C.d.S.); (P.E.B.G.); (R.C.V.); (A.d.P.S.)
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Mutebi F, McNeilly H, Thielecke M, Reichert F, Wiese S, Mukone G, Feldmeier H. Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda. Trop Med Infect Dis 2023; 8:tropicalmed8020111. [PMID: 36828527 PMCID: PMC9963877 DOI: 10.3390/tropicalmed8020111] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3-64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5-14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9-18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles.
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Affiliation(s)
- Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala P.O. Box 7062, Uganda
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
- Correspondence: or
| | - Hannah McNeilly
- Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Edinburgh EH8 9XD, UK
| | - Marlene Thielecke
- Charité Center for Global Health, Institute of International Health, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - Susanne Wiese
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - George Mukone
- Innovations for Tropical Disease Elimination (IFOTRODE), Kampala P.O. Box 24461, Uganda
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
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Saboyá-Díaz MI, Nicholls RS, Castellanos LG, Feldmeier H. Current status of the knowledge on the epidemiology of tungiasis in the Americas. Rev Panam Salud Publica 2022; 46:e124. [PMID: 36060204 PMCID: PMC9426953 DOI: 10.26633/rpsp.2022.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives. To present the state-of-the-knowledge on the epidemiology of tungiasis in the Region of the Americas. Methods. A search of publications on the epidemiology of tungiasis in the Americas was performed in PubMed and LILACS databases from January 2007 to June 2021. In addition, a manual literature search on articles on the epidemiology of tungiasis was performed. Results. A total of 83 articles were analyzed which contained relevant information on tungiasis cases and their geographical distribution, prevalence and risk factors, life cycle, sites where transmission takes place, and zoonotic aspects. The on-host and off-host life cycles have been researched in detail. In certain contexts, the whole life cycle is completed indoors enabling transmission around the whole year. Cases were reported from 10 countries; 71% of them were from Brazil. In the general population, the prevalence varied between 1.0% and 82.6% according to the settings. Age-specific prevalence indicated that children and the elderly bear the highest disease burden. Risk factor studies indicate that tungiasis is associated with severe poverty. Conclusions. In the Americas, there are important gaps in information and knowledge of tungiasis. Understanding the burden, epidemiology, distribution, magnitude, related risk factors, and reservoirs, among others, is needed to develop and implement integrated control measures tailored to the context and patterns of transmission in the affected communities.
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Affiliation(s)
- Martha Idalí Saboyá-Díaz
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - Rubén Santiago Nicholls
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - Luis Gerardo Castellanos
- Pan American Health Organization Washington, DC United States of America Pan American Health Organization, Washington, DC, United States of America
| | - Hermann Feldmeier
- University Medicine Berlin Berlin Germany University Medicine Berlin, Berlin, Germany
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Harvey TV, Linardi PM, Carlos RSA, Heukelbach J. Tungiasis in domestic, wild, and synanthropic animals in Brazil. Acta Trop 2021; 222:106068. [PMID: 34331896 DOI: 10.1016/j.actatropica.2021.106068] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Tungiasis is an ectoparasitic skin disease of humans and warm-blooded animals caused by fleas of the genus Tunga (Jarocki, 1938). Dogs, cats, pigs, and synanthropic rodents are the main animal reservoirs. Of the 14 known species, 12 are found in Latin America and, among these, eight are found in Brazil, including the two zoonotic species Tunga penetrans and Tunga trimamillata. Tunga penetrans predominates among humans and Brazilian pets, where the dog is the most affected species, and its presence is a risk factor associated with the disease in humans. Tunga spp. are widely distributed throughout the national territory, with T. penetrans being the most dispersed and the most frequent in animals from endemic areas, especially in underprivileged communities. Infections in animals, associated with inadequate management, favor the spread and perpetuation of the disease. Intense injuries can result in sequelae and serious clinical conditions, compromising the health, welfare, and productivity of animals, as well as leading to death. Health precariousness, lack of control and neglect in the management of populations of domestic and synanthropic animals, poor hygiene habits of individuals, lack of information from both the population and related professionals, lack of effective treatment, and of perception of tungiasis as a disease are among the main challenges for the control of this parasitosis. As recommended for other zoonotic Neglected Tropical Diseases, strategies based on the concept of One Health can guarantee more effective results in the fight against human and animal tungiasis.
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Affiliation(s)
- Tatiani Vitor Harvey
- Autonomous Veterinarian, 16 Aberdeen Avenue, Cambridge, MA, Zipcode 02138, United States.
| | - Pedro Marcos Linardi
- UFMG. Universidade Federal de Minas Gerais, Departamento de Parasitologia, Instituto de Ciências Biológicas, Caixa Postal 486, Avenida Antônio Carlos, 6627, Campus UFMG, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil.
| | - Renata Santiago Alberto Carlos
- UESC. Universidade Estadual de Santa Cruz, Departamento de Ciências Agrárias e Ambientais, Faculdade de Medicina Veterinária, Campus Soane Nazaré de Andrade. Rodovia Jorge Amado Km 16. Bairro Salobrinho. Ilhéus, Bahia, CEP 45662-900, Brazil.
| | - Jorg Heukelbach
- Postgraduate Program in Public Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, CEP 60.430-140, Brazil.
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Enwemiwe VN, Ojianwuna CC, Anyaele OO. Intensity and clinical morbidities of tungiasis in an impoverished south-west Nigerian community. Parasite Epidemiol Control 2021; 14:e00215. [PMID: 34124398 PMCID: PMC8173311 DOI: 10.1016/j.parepi.2021.e00215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/10/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022] Open
Abstract
Sand fleas infestation, Tunga penetrans, remains a neglected tropical disease of public-health concern in many countries. Tungiasis can lead to destruction of the feet causing serious discomfort and deformities. This study aim was to determine the intensity rate and clinical morbidities of tungiasis among the people living in Igbokoda, Ondo State, Nigeria. A community-based cross-sectional survey was conducted among households in three villages in Igbokoda. Hands and feet of selected household members were examined, while fleas on different floor types of houses were sampled by soil collection and extraction by tullgren funnel method. Sand fleas were equally sampled from legs of infested individuals by hand picking. Intensity was determined in terms of number of lesions and fleas in different floor-types. Tungiasis-associated morbidities was assessed using acute and chronic lesions severity scores. The study revealed that moderate infestation was observed in 173 infested individuals and severe infestation in 16 infested individuals. A total of 5293 lesions was observed out of which 3098 were viable. The flea burdens on sampled floors and legs were 127 and 146 fleas respectively occurring mostly in unpaved veranda and rooms (65 and 62 fleas respectively). Tungiasis lesions observed in males were more intense compared to females. Flea lesions and burdens with respect to age stratification and location were significant P < 0.0001. Difficulty in walking, pain upon pressure and deformation of the feet were the most common tungiasis-associated morbidity recorded. Also, tungiasis-associated morbidities, and flea number sampled on legs and on floor of environment were reportedly intense. Therefore, scaling up an appropriate and affordable intervention approach targeted at the fleas would serve as a relief to the scourge of tungiasis in Igbokoda community.
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Affiliation(s)
- Victor N Enwemiwe
- Department of Animal and Environmental Biology, Delta State University, Abraka, Nigeria.,Department of Zoology, University of Ibadan, Ibadan, Nigeria
| | - Cynthia C Ojianwuna
- Department of Animal and Environmental Biology, Delta State University, Abraka, Nigeria
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Anyaele OO, Enwemiwe VN. Prevalence of tungiasis in rural poor neighbourhood in Igbokoda, Ondo State, Nigeria. AFRICAN ZOOLOGY 2021. [DOI: 10.1080/15627020.2021.1901604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Victor N Enwemiwe
- Department of Zoology, University of Ibadan, Ibadan, Nigeria
- Department of Animal and Environmental Biology, Delta State University, Nigeria
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Sood A, Raman DK, Joshi RK, Gupta D. Tungiasis: Outbreak investigation of a zoonosis during overseas deployment. Med J Armed Forces India 2017; 73:375-379. [PMID: 29386713 DOI: 10.1016/j.mjafi.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022] Open
Abstract
Background Tungiasis is an ectoparasitosis caused by the sand flea Tunga penetrans. It is endemic in the under privileged communities of Latin America, the Caribbean and Sub Saharan Africa with geographic and seasonal variations even within endemic areas. We describe investigation of an outbreak of Tungiasis in troops deployed as part of UN peacekeeping force in Central Africa. Methods Tungiasis was diagnosed in an unusually large number of cases of severely pruritic boils over feet in soldiers of a UN peacekeeping battalion. An outbreak investigation was carried out and the outbreak was described in time, place and person distribution. A retrospective cohort study was done to ascertain the associated risk factors. Results A total of 36 cases were identified of which 33 had laboratory confirmation. Of the 36 cases, 10(27.77%) had only Fortaleza Stage II lesions, 22 (61.11%) a combination of Fortaleza Stage II and III lesions and four (11.11%) cases had a combination of Stage, II, III and IV lesions. Secondary bacterial infection was seen in 25 (69.44%) cases. Epidemiological analysis revealed that it was a common source single exposure outbreak traced to a temporary campsite along one of the patrolling routes. Conclusion In a Military setting an integrated approach combining health education and environmental control is required to prevent such outbreaks.
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Affiliation(s)
- Aradhana Sood
- Associate Professor, Department of Dermatology & Venereology, Armed Forces Medical College, Pune 411040, India
| | - D K Raman
- Associate Professor, Department of Pathology, Armed Forces Medical College, Pune 411040, India
| | - R K Joshi
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Darpan Gupta
- Classified Specialist (Surgery), Command Hospital (Western Command), Chandimandir, India
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Wiese S, Elson L, Reichert F, Mambo B, Feldmeier H. Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. Results from a community-based study. PLoS Negl Trop Dis 2017; 11:e0005925. [PMID: 28991909 PMCID: PMC5648262 DOI: 10.1371/journal.pntd.0005925] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/19/2017] [Accepted: 09/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tungiasis is a neglected tropical disease caused by female sand fleas (Tunga penetrans) embedded in the skin. The disease is associated with important morbidity. Tungiasis is endemic along the Coast of Kenya with a prevalence ranging from 11% to 50% in school-age children. Hitherto, studies on epidemiological characteristics of tungiasis in Africa are scanty. METHODS In a cross-sectional study 1,086 individuals from 233 households in eight villages located in Kakuyuni and Malanga Sub-locations, Kilifi County, on the Kenyan Coast, were investigated. Study participants were examined systematically and the presence and severity of tungiasis were determined using standard methods. Demographic, socio-economic, environmental and behavioral risk factors of tungiasis were assessed using a structured questionnaire. Data were analyzed using bivariate and multivariate regression analysis. RESULTS The overall prevalence of tungiasis was 25.0% (95% CI 22.4-27.5%). Age-specific prevalence followed an S-shaped curve, peaking in the under-15 year old group. In 42.5% of the households at least one individual had tungiasis. 15.1% of patients were severely infected (≥ 30 lesions). In the bivariate analysis no specific animal species was identified as a risk factor for tungiasis. Multivariate analysis showed that the occurrence of tungiasis was related to living in a house with poor construction characteristics, such as mud walls (OR 3.35; 95% CI 1.71-6.58), sleeping directly on the floor (OR 1.68; 95% CI 1.03-2.74), the number of people per sleeping room (OR = 1.77; 95% CI 1.07-2.93) and washing the body without soap (OR = 7.36; 95% CI 3.08-17.62). The odds of having severe tungiasis were high in males (OR 2.29; 95% CI 1.18-44.6) and were very high when only mud puddles were available as a water source and lack of water permitted washing only once a day (OR 25.48 (95% CI 3.50-185.67) and OR 2.23 (95% CI 1.11-4.51), respectively). CONCLUSIONS The results of this study show that in rural Kenya characteristics of poverty determine the occurrence and the severity of tungiasis. Intra-domiciliary transmission seems to occur regularly.
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Affiliation(s)
- Susanne Wiese
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
- * E-mail:
| | - Lynne Elson
- WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Watamu, Kenya
| | - Felix Reichert
- Department of Pediatrics, Charité University Medicine, Berlin, Germany
| | - Barbara Mambo
- Kilifi County Research Group, Kilifi County Hospital, Kilifi, Kenya
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
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Control of Tungiasis in Absence of a Roadmap: Grassroots and Global Approaches. Trop Med Infect Dis 2017; 2:tropicalmed2030033. [PMID: 30270889 PMCID: PMC6082108 DOI: 10.3390/tropicalmed2030033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 11/16/2022] Open
Abstract
Tungiasis is a tropical skin disease caused by the sand flea Tunga penetrans. It inflicts misery upon tens of millions of people, mostly children, across Central and South America and sub-Saharan Africa, and yet there is no globally accepted roadmap for its control. Here we review how research in the last 15 years has developed control methods and report on new grassroots and digital mapping approaches. Treatment is now possible with a two-component dimethicone, used for the treatment of headlice in Europe, Asia and Canada, but not yet available in most tungiasis-endemic areas. Prevention is possible through the daily use of repellents based on coconut oil. A Kenyan coastal community has successfully controlled tungiasis using a neem and coconut oil mix produced locally to treat cases, combined with spraying floors with neem solution and distributing closed shoes. Development of affordable hard floor technology is underway, although not yet widely available, but is a priority to control off-host stages in the floors of homes. A new web-based digital mapping application will enable researchers and health officials to collaborate, share data and map the prevalence of tungiasis. We conclude that tungiasis can be controlled through a multi-disciplinary, One Health approach.
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Ugbomoiko US, Ariza L, Babamale AO, Heukelbach J. Prevalence and clinical aspects of tungiasis in south-west Nigerian schoolchildren. Trop Doct 2016; 47:34-38. [PMID: 27402650 DOI: 10.1177/0049475516657503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tungiasis is highly prevalent in resource-poor communities in sub-Saharan Africa, but studies among schoolchildren are scanty. We assessed prevalence, parasite load and clinical aspects of tungiasis in schoolchildren in south-western Nigeria. A total of 545 schoolchildren was examined. Of these, 133 (24.4%; 95% CI, 20.9-28.2%) were infested with Tunga penetrans Boys showed a higher prevalence than girls (31% versus 18%, P < 0.0001); in those infested, the median number of lesions was two, with no gender difference (2 boys, interquartile range, 1-4; 2 girls; interquartile range, 1-4; P = 0.34). The maximum number of 44 lesions was found in a 14-year-old boy. Desquamation was present in 90.2%, followed by erythema (54.9%) and oedema (43.6%); 54.9% showed any chronic pathology and more one-third nail deformations. Our study indicates that tungiasis is an important health problem in rural Nigerian schoolchildren. Sustainable interventions are required to control the disease in this and similar communities.
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Affiliation(s)
| | - Liana Ariza
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil .,Anton Breinl Centre for Public Health and College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
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Feldmeier H, Heukelbach J, Ugbomoiko US, Sentongo E, Mbabazi P, von Samson-Himmelstjerna G, Krantz I. Tungiasis--a neglected disease with many challenges for global public health. PLoS Negl Trop Dis 2014; 8:e3133. [PMID: 25356978 PMCID: PMC4214674 DOI: 10.1371/journal.pntd.0003133] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hermann Feldmeier
- Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- * E-mail:
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Elizabeth Sentongo
- Makerere University College of Health Sciences, School of Biomedical Sciences, Department of Medical Microbiology, Kampala, Uganda
| | | | - Georg von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Faculty of Veterinary Medicine, Freie Universität, Berlin, Germany
| | - Ingela Krantz
- Skaraborg Institute for Research and Development, Skövde, Sweden
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Feldmeier H, Keysers A. Tungiasis - A Janus-faced parasitic skin disease. Travel Med Infect Dis 2013; 11:357-65. [PMID: 24211240 DOI: 10.1016/j.tmaid.2013.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/23/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
Tungiasis is a parasitic skin disease caused by the penetration of female sand fleas (Tunga penetrans). It is acquired when people walk barefoot or rest on soil, where sand fleas have completed the off-host cycle. Tungiasis is a classic poverty-associated disease which belongs to the family of neglected tropical diseases (NTD). It has a Janus-face: while in travellers tungiasis usually is a benign self-limiting skin disease, inhabitants of endemic areas suffer from heavy infestations and severe, frequently debilitating and incapacitating morbidity. We describe the epidemiological and clinical characteristics of travel-associated tungiasis and compare these features to the situation in resource-poor communities in South America and sub-Saharan Africa.
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Affiliation(s)
- Hermann Feldmeier
- Institute of Microbiology and Hygiene, Charité Medical School, Campus Benjamin Franklin, Hindenburgdamm 27, D-12203 Berlin, Germany.
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Tungiasis (sand flea disease): a parasitic disease with particular challenges for public health. Eur J Clin Microbiol Infect Dis 2012; 32:19-26. [PMID: 22941398 DOI: 10.1007/s10096-012-1725-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
Tungiasis (sand flea disease) is caused by the penetration of females of Tunga penetrans into the skin of the feet. Within 2 weeks of penetration the burrowed flea increases its volume by a factor of 2,000. This is paralleled by intense inflammation of the surrounding tissue. Acute and chronic inflammation leads to the development of painful and debilitating clinical pathology. This results in impaired physical fitness and mobility. The social implications of tungiasis-associated morbidity are multifold. Children with tungiasis are teased and ridiculed, adults feel ashamed and stigmatized. There is anecdotal evidence that tungiasis negatively affects educational achievements. Impaired mobility and physical fitness will have a negative impact on household economics. Sand flea disease is common in resource-poor communities in South America and in sub-Saharan Africa with prevalence in the general population of up to 60%. In East Africa, it has re-emerged in epidemic dimensions in recent years. Hitherto, no effective drug treatment has been at hand. Traditional treatment, i.e., the manipulation of burrowed sand fleas with blunt and inappropriate instruments may facilitate the transmission of blood-derived pathogens. Prevention is feasible through regular application of a repellent based on coconut oil. Owing to its strong association with poverty, sand flea disease would be an excellent starting point for a community-based fight against rural poverty.
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Buckendahl J, Heukelbach J, Ariza L, Kehr JD, Seidenschwang M, Feldmeier H. Control of tungiasis through intermittent application of a plant-based repellent: an intervention study in a resource-poor community in Brazil. PLoS Negl Trop Dis 2010; 4:e879. [PMID: 21085467 PMCID: PMC2976681 DOI: 10.1371/journal.pntd.0000879] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 10/12/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tungiasis, an ectoparasitosis caused by the female sand flea Tunga penetrans, is an important health problem in many impoverished communities in the tropics. Sand flea disease is associated with a broad spectrum of clinical pathology and severe sequels are frequent. Treatment options are limited. METHODOLOGY/PRINCIPAL FINDINGS We assessed the effectiveness of the intermittent application of the plant-based repellent Zanzarin to reduce infestation intensity and tungiasis-associated morbidity in a resource-poor community in Brazil, characterized by a very high attack rate. The study population was randomized into three cohorts. Initially, during a period of four weeks, the repellent was applied twice daily to the feet of all cohort members. This reduced the number of embedded sandfleas to 0 in 98% of the participants. Thereafter members of cohort A applied the repellent every second week twice daily for one week, members of cohort B every fourth week for one week, and members of cohort C served as controls. Infestation intensity and tungiasis-associated morbidity were monitored during five months. The intermittent application of Zanzarin for one week every second week significantly reduced infestation intensity from a median 4 lesions (IQR 1-9) during the whole transmission season. In contrast, in cohort B (application of the repellent every fourth week) the infestation intensity remained twice as high (median 8 lesions, IQR 9-16; p = 0.0035), and in the control cohort C 3.5 times as high (median 14 lesions; IQR 7-26; p = 0.004 during the transmission season). Tungiasis-related acute pathology remained very low in cohort A (median severity score 2; IQR 1-4) as compared to cohort B (median severity score 5; IQR 3-7; p<0.001), and control cohort C (median severity score 6.5; IQR 4-8; p<0.001). CONCLUSIONS/SIGNIFICANCE Our study shows that in a setting with intense transmission, tungiasis-associated morbidity can be minimized through the intermittent application of a plant-based repellent.
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Affiliation(s)
- John Buckendahl
- Department of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Jörg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Liana Ariza
- Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Judith Dorothea Kehr
- Department of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Martin Seidenschwang
- Department of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
| | - Hermann Feldmeier
- Department of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
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Tungiasis en población indígena del departamento de Vaupés: epidemiología, clínica, tratamiento y prevención. BIOMEDICA 2010. [DOI: 10.7705/biomedica.v30i2.185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pilger D, Schwalfenberg S, Heukelbach J, Witt L, Mencke N, Khakban A, Feldmeier H. Controlling tungiasis in an impoverished community: an intervention study. PLoS Negl Trop Dis 2008; 2:e324. [PMID: 18941513 PMCID: PMC2565488 DOI: 10.1371/journal.pntd.0000324] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 09/26/2008] [Indexed: 11/20/2022] Open
Abstract
Background In Brazil, tungiasis is endemic in some resource-poor communities where various domestic and sylvatic animals act as reservoirs for this zoonosis. To determine the effect of control measures on the prevalence and intensity of infestation of human and animal tungiasis, a repeated cross-sectional survey with intervention was carried out. Methodology/Principal Findings In a traditional fishing community in Northeast Brazil, humans and reservoir animals were treated, and premise-spraying using an insecticide was done, while a second fishing community served as a control. Both communities were followed up 10 times during a 12-month period. At baseline, prevalence of tungiasis was 43% (95% confidence interval [CI]: 35%–51%) and 37% (95% CI: 31%–43%) in control and intervention villages, respectively. During the study, prevalence of tungiasis dropped to 10% (95% CI: 8%–13%; p<0.001) in the intervention village, while the prevalence remained at a high level in the control village. However, after one year, at the end of the study, in both communities the prevalence of the infestation had reached pre-intervention levels. Whereas the intensity of infestation was significantly reduced in the intervention community (p<0.001), and remained low at the end of the study (p<0.001), it did not change in the control village. Conclusion/Significance Our study shows that a reduction of prevalence and intensity of infestation is possible, but in impoverished communities a long-lasting reduction of disease occurrence can only be achieved by the regular treatment of infested humans, the elimination of animal reservoirs, and, likely, through environmental changes. Trial Registration Controlled-Trials.com ISRCTN27670575 Tungiasis is a disease caused by the sand flea Tunga penetrans, a parasite prevalent in many impoverished communities in developing countries. The female sand flea penetrates into the skin of animals and humans where it grows rapidly in size, feeds on the host's blood, produces eggs which are expelled into the environment, and eventually dies in situ. The lesions become frequently superinfected and the infestation is associated with considerable morbidity. Clearly, tungiasis is a neglected disease of neglected populations. We investigated the impact of a package of intervention measures targeted against on-host and off-host stages of T. penetrans in a fishing community in Northeast Brazil. These measures decreased disease occurrence only temporarily, but had a sustained effect on the intensity of the infestation. Since infestation intensity and morbidity are correlated, presumably the intervention also lowered tungiasis-associated morbidity. Control measures similar to the ones used in this study may help to effectively control tungiasis in impoverished communities.
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Affiliation(s)
- Daniel Pilger
- Institute for Microbiology and Hygiene, Charité–University of Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Schwalfenberg
- Institute for Microbiology and Hygiene, Charité–University of Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Jörg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Mandacaru Foundation, Fortaleza, Brazil
| | - Lars Witt
- Institute for Microbiology and Hygiene, Charité–University of Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Norbert Mencke
- Bayer HealthCare AG, Animal Health Division, Leverkusen, Germany
| | - Adak Khakban
- Institute for Microbiology and Hygiene, Charité–University of Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Hermann Feldmeier
- Institute for Microbiology and Hygiene, Charité–University of Medicine, Campus Benjamin Franklin, Berlin, Germany
- * E-mail:
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Gatti FR, Oliveira CMD, Servilha TR, Sanchez APG. Tungíase disseminada tratada com ivermectina. An Bras Dermatol 2008. [DOI: 10.1590/s0365-05962008000400009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A tungíase é ectoparasitose causada pela penetração da Tunga penetrans na pele do hospedeiro. A infestação por essa pulga está associada à pobreza e ocorre em comunidades carentes na América do Sul e Central, no Caribe e na África sul-sahariana. No Brasil, é mais prevalente em assentamentos urbanos precários, áreas rurais e comunidades de pescadores em todo o país. O tratamento consiste na retirada dos parasitas e, nos casos com infecção secundária, antibioticoterapia. Até o momento, não há droga no mercado com eficácia clínica satisfatória. Relata-se caso de tungíase disseminada tratada com ivermectina oral.
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Escamilla-Martinez E, Gómez-Martín B, Sánchez-Rodríguez R, Martínez-Nova A, Martínez-Granada LJ, Altube-Arabiurrutia E. Tungiasis--traveler's ectoparasitosis of the foot: a case report. Foot Ankle Int 2008; 29:354-7. [PMID: 18348837 DOI: 10.3113/fai.2008.0354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Elena Escamilla-Martinez
- Departamento de Enfermería, Universidad de Extremadura, Centro Universitario, Plasencia (Cáceres), Spain.
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Ariza L, Seidenschwang M, Buckendahl J, Gomide M, Feldmeier H, Heukelbach J. [Tungiasis: a neglected disease causing severe morbidity in a shantytown in Fortaleza, State of Ceará]. Rev Soc Bras Med Trop 2007; 40:63-7. [PMID: 17486257 DOI: 10.1590/s0037-86822007000100013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 01/17/2007] [Indexed: 11/22/2022] Open
Abstract
The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
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Affiliation(s)
- Liana Ariza
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
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Ugbomoiko US, Ofoezie IE, Heukelbach J. Tungiasis: high prevalence, parasite load, and morbidity in a rural community in Lagos State, Nigeria. Int J Dermatol 2007; 46:475-81. [PMID: 17472674 DOI: 10.1111/j.1365-4632.2007.03245.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tungiasis is common in resource-poor populations throughout Latin America, the Caribbean, and sub-Saharan Africa, but epidemiologic data from Africa on this ectoparasitosis are scarce. METHODS A cross-sectional study was carried out in a representative sample of a rural community in Lagos State, 54 km west of Lagos (Nigeria). In the dry season, 142 households of the community were randomly selected and visited. Family members were examined for the presence of tungiasis. The localization, number, and stage of penetrated fleas, as well as the associated morbidity, were documented. RESULTS Five hundred and fifty-seven individuals were examined, 299 (53.7%) males and 258 (46.3%) females. In total, 252 (45.2%; 95% confidence interval, 41.1-49.5) were infested with Tunga penetrans. The prevalence was highest between the ages of 5 and 14 years, decreased in adults, and increased again in the elderly. There was no statistically significant difference between the prevalence in males and females (47.2% vs. 43.0%; P = 0.3). Almost 95% of lesions were localized on the feet. Ten per cent of individuals presented with sand fleas on the hands and elbows. The median parasite load was six (interquartile range, 3-16). Individuals aged 60 years or over had significantly more lesions (median of 41 lesions; P < 0.01). About one-third of the study participants found it difficult to walk; in 10% of cases, fissures were present. Superinfection was common. CONCLUSIONS The prevalence of tungiasis and the parasite load were high, and the severity of the disease was considerable. The prevalence and parasite burden showed a characteristic distribution. In western Nigeria, tungiasis needs to be regarded as an important public health problem.
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Kehr JD, Heukelbach J, Mehlhorn H, Feldmeier H. Morbidity assessment in sand flea disease (tungiasis). Parasitol Res 2006; 100:413-21. [PMID: 17058108 DOI: 10.1007/s00436-006-0348-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Accepted: 09/13/2006] [Indexed: 11/29/2022]
Abstract
Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.
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Affiliation(s)
- Judith Dorothea Kehr
- Institute of Microbiology and Hygiene, Charité-University Medicine, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Germany
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